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Tuesday, December 16, 2008

PHARMACOGENOMICS

Each of us responds differently to our environment, to the foods we eat, and to the drugs we take. The way we respond to drugs may mean that a drug that is effective for one person may be less effective for another, or that a drug that is safe for one person may be dangerous for another person—even at the same dosage.


Many drugs are altered by the body by metabolizing them using enzymes. In some cases, an active drug is made inactive or less active through metabolism. In other cases, an inactive or less active drug is made more active through metabolism. The challenge in drug therapy is to make sure that the active form of a drug stays around long enough to do its job. However, some of us have enzymes that are a little different than the “normal” so we may metabolize the drug too quickly or too slowly or not at all — meaning that it may be gone before it has its intended effect, or hangs around too long and may build up beyond safe levels.


Pharmacogenomics is the study of how drugs are metabolized in the body and the variations in the genes that produce the metabolizing enzymes. By studying the genes that produce the specific enzymes that metabolize a drug that is to be prescribed, a doctor may decide to raise or lower the dose, or even change to a different drug. The decision about which drug to prescribe may also be influenced by other drugs the patient is taking, to avoid drug-drug interactions.


Currently, doctors typically prescribe one of several appropriate drugs for their patients. They prescribe a “standard” dose based on factors such as weight, sex, and age, and then adjust the dose over time, depending on whether the patient’s condition is responding to the medication and whether the patient is experiencing unpleasant or dangerous side effects. The concentrations of some drugs are monitored with blood tests and the dosages increased or decreased to maintain the drug level in an established “therapeutic” range. Follow-up of such processes is called “Therapeutic Drug Monitoring.” If the drug is not effective in treating or controlling the patient’s condition, then the patient is given a different drug and the process is started again.


Instead, pharmacogenomics offers physicians the opportunity to individualize drug therapy for patients based on their genetic make-up. For certain drugs, pharmacogenomics is already helping physicians predetermine dosages to have a better chance of achieving the desired therapeutic effect while reducing the likelihood of adverse effects.

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